摘要
目的 探讨子宫动脉血流多普勒超声检查联合血清胎盘生长因子(PIGF)和D-二聚体(D-D)与孕中期子痫前期孕妇妊娠结局及新生儿预后的相关性。方法 将2019年1月至2022年8月江阴市中医院(南京中医药大学江阴附属医院)就诊的89例孕中期先兆子痫孕妇纳入本次回顾性研究,设为先兆子痫组,另选择同时间段226例孕中期正常孕妇纳入对照组。比较各组孕20~26周子宫动脉血流参数[包括收缩期与舒张期流速比(S/D)、搏动指数(PI)和子宫动脉阻力指数(RI)],血清PIGF和D-D水平,Pearson相关性分析分析PIGF、D-D与S/D、PI和RI的相关性,比较不同母体结局及新生儿预后及子宫动脉血流参数、血清PIGF、D-D水平。结果 先兆子痫组S/D、PI和RI为3.35±0.26、2.21±0.12、0.84±0.21,均明显高于对照组(2.89±0.30、0.82±0.09、0.53±0.19),差异均有统计学意义(P<0.05)。先兆子痫组的血清PIGF为(13.41±0.59)μg/L,显著低于对照组[(42.35±2.21)μg/L],血清D-D为(598.05±79.51)μg/L,显著高于对照组[(264.19±45.96)μg/L],差异均有统计学意义(P<0.05)。Pearson相关性分析显示,PIGF与S/D、PI和RI呈负相关(r=-0.481、-0.509、0.489,P<0.05),而D-D与S/D、PI和RI呈正相关(r=0.422、0.447、0.438,P<0.05)。先兆子痫组新生儿出生孕周为(33.53±1.95)周,明显短于对照组[(38.97±2.27)周],出生体重及1 min Apgar评分分别为(2 324.10±413.77)g、(7.51±1.91)分,均明显低于对照组[(3 114.43±541.72)g、(9.50±1.83)分],差异均有统计学意义(P<0.05)。母体并发症发生率和新生儿不良预后发生率为68.54%(61/89)、47.19%(42/89)。母体并发症组的S/D、PI及RI、血清D-D水平均显著高于非母体并发症组,而血清PIGF水平显著低于非母体并发症组,差异均有统计学意义(P<0.05);新生儿预后不良组的的S/D、PI及RI、血清D-D水平显著高于预后良好组,而血清PIGF水平显著低于预后良好组,差异均有统计学意义(P<0.05)。结论 先兆子痫患者孕中期子宫动脉血流参数异常,血清PLGF、D-D表达异常,且先兆子痫患者新生儿预后差,孕中期子宫动脉血流参数、血清PLGF、D-D与先兆子痫患者母婴结局密切相关。
Objective To investigate the relationship of uterine artery blood flow doppler ultrasonography combined with serum placental growth factor(PIGF),D-dimer(D-D)with pregnancy outcome and neonatal prognosis in patients with preeclampsia at the second trimester of pregnancy.Methods A total of 89 pregnant women with preeclampsia in the second trimester of pregnancy in Jiangyin Traditional Chinese Medicine Hospital,Jiangyin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2019 to August 2022 were enrolled in this retrospective study and included in the preeclampsia group.Another 226 normal pregnant women in the second trimester of pregnancy at the same time were selected into the control group.The blood flow parameters of uterine artery(including S/D,PI,and RI),serum PIGF and D-D were compared at the 20th-26th week of pregnancy.[Pearson correlation analysis was used to analyze the correlation of PIGF,D-D with S/D,PI and RI.]Uterine artery blood flow parameters,serum PIGF and D-D of different maternal outcomes and neonatal prognosis groups were compared.Results S/D,PI and RI in preeclampsia group were 3.35±0.26,2.21±0.12,0.84±0.21,respectively,which were significantly higher than those in control group(2.89±0.30,0.82±0.09,(0.53±0.19),the differences were statistically significant(P<0.05).The level of serum PIGF in the preeclampsia group was(13.41±0.59)μg/L,which was significantly lower than that in the control group[(42.35±2.21)μg/L],the level of serum D-D in preeclampsia group was(598.05±79.51)μg/L,which was higher than that in the control group[(264.19±45.96)μg/L,the differences were statistically significant(P<0.05).[Pearson correlation analysis showed that PIGF was negatively correlated with S/D,PI and RI(r=-0.481,-0.509,-0.489,P<0.05),while D-D was positively correlated with S/D,PI and RI(r=0.422,0.447,and 0.438,P<0.05).]The gestational age of newborns in the preeclampsia group was(33.53±1.95)weeks,which was significantly shorter than that in the control group[(38.97±2.27)weeks],the birth weight and 1 min Apgar score were(2324.10±413.77)g and(7.51±1.91)points,respectively,which were significantly lower than those in the control group[(3114.43±541.72)g and(9.50±1.83)points],and the differences were statistically significant(P<0.05).The incidence of maternal complications and poor fetal prognosis were 68.54%(61/89)and 47.19%(42/89),respectively.S/D,PI,RI and the level of serum D-D of maternal complication group were significantly higher than those of non-maternal complication group,the level of serum PIGF was lower than that of on-maternal complication group,and the differences were statistically significant(P<0.05).S/D,PI,RI and the level of serum D-D in poor prognosis group were higher than those in good prognosis group,and the level of serum PIGF of poor prognosis group was lower than that of good prognosis group,and the differences were statistically significant(P<0.05).Conclusion Patients with preeclampsia have abnormal uterine artery blood flow parameters in mid pregnancy,abnormal expression of serum PLGF and D-D,and poor prognosis in newborns with preeclampsia.The parameters of uterine artery blood flow in mid pregnancy,serum PLGF and D-D are closely related to the maternal and infant outcomes of preeclampsia patients.
作者
朱莉华
唐琪
张子宁
周菊英
ZHU Li-hua;TANG Qi;ZHANG Zi-ning(Department of Ultrasound Medicine,Jiangyin Traditional Chinese Medicine Hospital,Jiangyin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Jiangyin Jiangsu 214400,China)
出处
《临床和实验医学杂志》
2024年第8期872-875,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省卫健委医学科研项目(编号:202002308)。
